Understanding MAT
Medication-assisted treatment is more than just medicine—it involves a comprehensive program of services curated by health care professionals, which includes counseling and behavioral therapies.
A closer look at the three key components of MAT:
FDA-approved medication
There are three FDA-approved medications that can be used to treat an opioid addiction1:
- Buprenorphine is an opioid partial agonist. It produces effects such as euphoria or respiratory depression at low to moderate doses. With buprenorphine, however, these effects are weaker than full opioid agonists such as methadone. As with all medications used in MAT, buprenorphine should be prescribed as part of a comprehensive treatment plan that includes counseling and other behavioral therapies to provide patients with a whole-person approach.
- Naltrexone is not an opioid, is not addictive, and does not cause withdrawal symptoms. Naltrexone blocks the euphoric and sedative effects of opioids such as heroin, morphine, and codeine.
- Methadone is a long-acting opioid agonist medication approved by the Food and Drug Administration (FDA) to treat Opioid Use Disorder (OUD) as a medication-assisted treatment (MAT). Methadone reduces opioid craving and withdrawal and blunts or blocks the effects of opioids. When taken as prescribed, methadone is safe and effective. Methadone helps individuals achieve and sustain recovery and to reclaim active and meaningful lives. Methadone is one component of a comprehensive treatment plan, which includes counseling and other behavioral health therapies to provide patients with a whole-person approach.
Counseling and behavioral therapies
Psychosocial services are personalized to every individual. This may include individual or group counseling, individual or group therapy or mutual help groups or case management.
Coordination of treatment with other medical needs
People with OUD are at higher risk for developing one or more primary conditions or chronic diseases. Because co-occurring disorders or chronic illnesses may require multiple medications, it is important to understand the serious adverse effects of combining medications used in MAT with other medications and to ensure coordination of care with other providers.
Providing medications without offering any psychosocial assistance fails to recognize the complex nature of opioid dependence.2
World Health Organization
Understanding MAT Delivery
To ensure both patient and community safety in managing powerful narcotics and effective treatment services, SAMHSA—the federal agency with oversight of our nation’s addiction treatment services—has developed specific regulations to guide care delivery.
Where MAT medications can be utilized:
| Methadone | Buprenorphine | Naltrexone | |
| Opioid Treatment Programs | |||
| Office Based Opioid Treatment | |||
| Primary Care |
| Methadone | |
| Opioid Treatment Programs | |
| Office Based Opioid Treatment | |
| Primary Care |
| Buprenorphine | |
| Opioid Treatment Programs | |
| Office Based Opioid Treatment | |
| Primary Care |
| Naltrexone | |
| Opioid Treatment Programs | |
| Office Based Opioid Treatment | |
| Primary Care |
There is disagreement regarding types or intensity of psychosocial services required to implement successful office-based models of care in primary care settings. While research has been focused on the pharmacology of MAT, there is widespread agreement across professional and public health organizations as well as federal agencies, that psychosocial treatment—counseling—is an essential component of MAT. 3
Why MAT Regulations Are Important
Methadone, buprenorphine and naltrexone are very different medications with different safety profiles. Naltrexone has no abuse or overdose potential. And while buprenorphine is an opioid, it has low abuse and overdose potential because of its partial-agonist properties and its ceiling effect that limits the activity beyond a certain dose.
Conversely, methadone, a full opioid agonist, is proven to be highly effective when used in the confines of a comprehensive and highly regulated opioid treatment program. However, if methadone is not properly administered and regulated, we could experience even greater stigma against MAT if an increase of people die misusing methadone. Now is the time to uphold the standard of medication-assisted treatment and help bend the curve of the opioid crisis.
1 https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions
2 https://www.who.int/publications/i/item/9789241547543
3 https://www.ncbi.nlm.nih.gov/books/NBK402343/